International Journal of Environmental Research and Public Health Case Report Understanding South Korea’s Response to the COVID-19 Outbreak: A Real-Time Analysis 1, , 1, , 1, , 2 Eunsun Jeong * y , Munire Hagose * y , Hyungul Jung * y, Moran Ki and Antoine Flahault 3 1 Institute of Global Health, University of Geneva, 1211 Geneva, Switzerland 2 Department of Cancer Control and Policy (DCCP), Graduate School of Cancer Science and Policy, National Cancer Centre (NCC), Goyang 10408, Korea; [email protected] 3 Institute of Global Health, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland; [email protected] * Correspondence: [email protected] (E.J.); [email protected] (M.H.); [email protected] (H.J.) These three authors contributed equally. y Received: 11 November 2020; Accepted: 16 December 2020; Published: 21 December 2020 Abstract: This case study focuses on the epidemiological situation of the COVID-19 outbreak, its impacts and the measures South Korea undertook during the first wave of the COVID-19 pandemic. Since the first case was confirmed on 20 January 2020, South Korea has been actively experiencing the COVID-19 outbreak. In the early stage of the pandemic, South Korea was one of the most-affected countries because of a large outbreak related to meetings of a religious movement, namely the Shincheonji Church of Jesus, in a city called Daegu and North Gyeongsang province. However, South Korea was held as a model for many other countries as it appeared to slow the spread of the outbreak with distinctive approaches and interventions. First of all, with drastic and early intervention strategies it conducted massive tracing and testing in a combination of case isolation. These measures were underpinned by transparent risk communication, civil society mobilization, improvement of accessibility and affordability of the treatment and test, the consistent public message on the potential benefit of wearing a mask, and innovation. Innovative measures include the mobile case-tracing application, mobile self-quarantine safety protection application, mobile self-diagnosis application, and drive-thru screening centres. Meanwhile, the epidemic has brought enormous impacts on society economically and socially. Given its relationship with China, where the outbreak originated, the economic impact in South Korea was predicted to be intense and it was already observed since February due to a decline in exports. The pandemic and measures undertaken by the government also have resulted in social conflicts and debates, human-right concerns, and political tension. Moreover, it was believed that the outbreak of COVID-19 and the governmental responses towards it has brought a huge impact on the general election in April. Despite of the large outbreak in late February, the Korean government has flattened the COVID-19 curve successfully and the downward trend in the number of new cases remained continuously as of 30 April. The most distinctive feature of South Korea’s responses is that South Korea conducted proactive case finding, contacts tracing, and isolations of cases instead of taking traditional measures of the containment of the epidemic such as boarder closures and lockdowns. Keywords: South Korea; coronavirus; COVID-19; global health; case study; epidemiology; non-pharmaceutical interventions; health systems Int. J. Environ. Res. Public Health 2020, 17, 9571; doi:10.3390/ijerph17249571 www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2020, 17, 9571 2 of 18 1. Introduction A novel coronavirus, namely COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) has emerged in Wuhan, China in December 2019. A few weeks later, the World Health Organization (WHO) announced the outbreak of a new virus. As the epidemic has spread across the world at an unprecedented rate, the WHO declared, on the 31st of January 2020, the 2019 novel coronavirus as a Public Health Emergency of International Concern [1]. Neighbouring countries to China such as Thailand and South Korea were the first countries to report cases before the virus started to spread worldwide. South Korea declared its first case on the 20th of January 2020 [2]. As the number of cases has rapidly soared due to the large outbreak related to religious meetings of the Shincheonji Church of Jesus [3], it became the second-most affected country in the world after China in late February. However, as the Republic of Korea combated the epidemic actively by taking proactive measures to reduce the number of daily new cases, the country handled the spread of COVID-19 impressively as soon as the first case was declared in its territory. As of April 23, it ranked 29th among the countries most affected by the virus, with 10,702 declared cases [4]. In 2015, South Korea was affected by the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). It recorded 186 cases, including 38 fatalities. The 2015 MERS outbreak revealed the weakness of South Korea’s healthcare system to tackle emerging and re-emerging infectious diseases. Since then, the Republic of Korea has made a change in the systems and policies to be capable of tackling the epidemics successfully [5]. As soon as the COVID-19 outbreak was announced in South Korea, a series of policies and interventions to contain the dissemination of the coronavirus disease were adopted, promptly and effectively. Research to develop a test kit was launched in mid-January, right after the Chinese government shared the genetic sequences of the virus [6]. Thus, when cases were rising up due to community transmission, it has already been able to detect and trace infected people and isolate them swiftly. South Korea remarkably controlled and flattened its curve without any national lockdown, even in Daegu and North Gyeongsang Province where most cases occurred [7]. All these reasons put South Korea as an interesting, but also important, country to analyse and discuss in order to have a clearer comprehension of the measures undertaken as there is no harmonized and coordinated measures worldwide. Scrutinizing how each country has responded to COVID-19 and its consequences may broaden our insights into the COVID-19 pandemic. The present case study will, first, identify the evolution of the outbreak in South Korea. Thereafter, non-pharmaceutical intervention measures undertaken, economic, political, and social impacts, and mathematical prediction will be discussed. 2. Methodology We conducted the case study by analysing the early responses of South Korea to the COVID-19 pandemic. It is a real-time analysis of the situation regarding the Covid-19 epidemic in South Korea as it was conducted during the ongoing pandemic. At the initial phase of the pandemic, the sources of data were limited and there were few peer-reviewed scientific researches available. Therefore, we utilized data from governmental websites such as Korea Centres for Disease Control and Prevention and Korea Ministry of Health and Welfare, governmental reports, WHO publications, scientific articles, and conventional media. The study highlights and analyses responses of the South Korean government through the scientific knowledge and resources we had in April 2020. Based on data provided by the Korean government, Korea Centres for Disease Control and Prevention, the United States Centres for Disease Control and Prevention, and the COVID tracking project, we were able to draw various figures by Microsoft Excel. In addition, the schematic diagram was developed to illustrate the non-pharmaceutical intervention measures. As this case study focuses on the first of the COVID-19 pandemic, all the epidemiological data presented are dated between January and April 2020. Int. J. Environ. Res. Public Health 2020, 17, 9571 3 of 18 3. Findings 3.1. Case Presentation 3.1.1. General Description South Korea is an East Asian country with 51 million inhabitants and half of the population is concentrated in the capital Seoul and its metropolitan area. The density of the population is estimated to be around 503 people per square kilometres, while the density of Seoul is approximately 17,000 people per square kilometres. The median age of the population is 42 years and the proportion of people older than 65 years is 15.5%. The life expectancy of the population is around 83 years. The country has a land border with North Korea and is surrounded by the Yellow Sea and the East Sea that are situated between South Korea and China and South Korea and Japan respectively [8]. According to the Organization for Economic Cooperation and Development (OECD), South Korea is a wealthy and developed country with access to high technologies. The country is considered as the 11th largest economy in the world [9]. Regarding the country’s economic system, the Republic of Korea relies mainly on a strategy of exporting goods. The top export partner is China, its neighbouring country [8]. The climate of South Korea is temperate with four distinct seasons. The annual mean temperature ranges from 10 C to 16 C. The coldest month is January, with a mean temperature ranges from 6 C ◦ ◦ − ◦ to 7 ◦C, while the warmest month is August, with a mean temperature range from 23 ◦C to 27 ◦C. The outbreak of the novel coronavirus in South Korea happened in winter, which is a cold and dry season [10]. Concerning the political aspect, South Korea is a democracy with a president, Moon Jae-In since May 2017. Moon Jae-In is from the Democratic Party of Korea, which is known as a centre-left party. The country has a unicameral parliament composed of 300 members elected for four years. Currently, the Democratic Party of Korea, the president’s party, is the most represented in the National Assembly [11]. 3.1.2. Healthcare System Overall, South Korea’s health care system is described as being one of the greatest. The government expenditure for the health system was about 7.6% of its GDP in 2017 [12].